Global, regional, and national causes of death in children and adolescents younger than 20 years: an open data portal with estimates for 2000–21
Authors: Francisco Villavicencio, Jamie Perin, Hallie Eilerts-Spinelli, Diana Yeung, David Prieto-Merino, Lucia Hug, David Sharrow, Danzhen You, Kathleen L Strong, Robert E Black, Li Liu
Journal: The Lancet Global Health (2023)

Almost 6·5 million children and adolescents younger than 20 years died globally in 2021, the vast majority from preventable causes.1United Nations Inter-agency Group for Child Mortality EstimationLevels & Trends in Child Mortality: Report 2022, estimates developed by the United Nations Inter-agency Group of Child Mortality Estimation. United Nations Children's Fund, New York, NY2023Google Scholar Reliable and timely data on causes of death are needed to better focus the attention of the global community on improving the survival of children and adolescents and to guide effective policy and programmes. But no less importantly, these data must be publicly available and easily accessible. We introduce an open data portal with yearly estimates on causes of death for children and adolescents younger than 20 years for the period 2000–21. The data hosted in this portal are part of a joint effort between the Child and Adolescent Causes of Death Estimation (CA CODE) project and the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). The portal is managed by UNICEF and was first launched in 2008 by UN IGME, reporting global, regional, and national age-specific all-cause mortality estimates for stillbirths, children, and adolescents.1United Nations Inter-agency Group for Child Mortality EstimationLevels & Trends in Child Mortality: Report 2022, estimates developed by the United Nations Inter-agency Group of Child Mortality Estimation. United Nations Children's Fund, New York, NY2023Google Scholar Cause-specific mortality estimates produced by the CA CODE project have now been incorporated for the first time, aiming to start a dialogue with countries about their mortality data to improve cause-specific estimates while increasing data transparency and use at the country level. The CA CODE project builds upon previous extensive research on causes of death, which had been carried out in collaboration with WHO and other UN agencies.2Black RE Cousens S Johnson HL et al.Global, regional, and national causes of child mortality in 2008: a systematic analysis.Lancet. 2010; 375: 1969-1987Summary Full Text Full Text PDF PubMed Scopus (2159) Google Scholar, 3Liu L Johnson HL Cousens S et al.Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000.Lancet. 2012; 379: 2151-2161Summary Full Text Full Text PDF PubMed Scopus (2873) Google Scholar, 4Liu L Oza S Hogan D et al.Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals.Lancet. 2016; 388: 3027-3035Summary Full Text Full Text PDF PubMed Scopus (2094) Google Scholar, 5Perin J Mulick A Yeung D et al.Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals.Lancet Child Adolesc Health. 2022; 6: 106-115Summary Full Text Full Text PDF PubMed Scopus (262) Google Scholar, 6Liu L Villavicencio F Yeung D et al.National, regional, and global causes of mortality in 5-19-year-olds from 2000 to 2019: a systematic analysis.Lancet Glob Health. 2022; 10: e337-e347Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar In addition to hosting all-cause mortality data and estimates, the childmortality.org portal now includes causes of death for 195 countries, nine world regions, and at the global level. The portal increases the transparency of the mortality estimation process by allowing analysis, comparisons, visualisations, and download of estimates on three cause-specific mortality indicators: number of deaths, mortality fractions, and rates (all reported with their uncertainty levels). Six age groups are represented: neonates (first 28 days of life), 1–59 months, younger than 5 years (aggregation of the previous two catagories), 5–9 years, 10–14 years, and 15–19 years. For the oldest age group, estimates are also split by sex. Causes of death are estimated separately for countries with high versus low mortality, by data availability, and by age group. Empirical cause-of-death data were gathered through systematic review, known investigator tracing, and procurement of national and subnational studies. We adapted the Bayesian least absolute shrinkage and selection operator (known as LASSO) approach7Park T Casella G The Bayesian Lasso.J Am Stat Assoc. 2008; 103: 681-686Crossref Scopus (1862) Google Scholar to address data scarcity, enhance robustness, and assess the uncertainty of the estimates on a coherent framework. All-cause mortality estimates were harmonised with UN IGME, and estimates for a small number of low-burden causes (eg, measles, collective violence, or HIV/AIDS) were systematically integrated from WHO and UNAIDS. Additional details on the methods have been published previously.5Perin J Mulick A Yeung D et al.Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals.Lancet Child Adolesc Health. 2022; 6: 106-115Summary Full Text Full Text PDF PubMed Scopus (262) Google Scholar, 6Liu L Villavicencio F Yeung D et al.National, regional, and global causes of mortality in 5-19-year-olds from 2000 to 2019: a systematic analysis.Lancet Glob Health. 2022; 10: e337-e347Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 8Mulick AR Oza S Prieto-Merino D Villavicencio F Cousens S Perin J A Bayesian hierarchical model with integrated covariate selection and misclassification matrices to estimate neonatal and child causes of death.J R Stat Soc Ser A Stat Soc. 2022; 185: 2097-2120Crossref Scopus (0) Google Scholar These estimates have been reviewed and endorsed by WHO Member States through country consultation. At the global level, there were 6 491 000 deaths in children and adolescents younger than 20 years in 2021, with 5 096 000 (78·5%) deaths in children younger than 5 years and 1 395 000 (21·5%) deaths in children and adolescents aged 5–19 years. Prematurity was the main cause of death in people younger than 20 years, with almost 1 million deaths in 2021, representing 18·1% of deaths in children younger than 5 years (figure). Lower respiratory infections (784 600 total deaths, 14·2% of deaths in children younger than 5 years, and 4·2% of deaths in those aged 5–19 years), birth asphyxia or trauma (588 200 deaths, 11·5% of deaths in children younger than 5 years), and malaria (535 400 deaths, 8·8% of deaths in children younger than 5 years and 6·1% of deaths in those aged 5–19 years) are the next leading causes of death. Also noticeable are road traffic injuries with 109 900 global deaths in 2021, representing 7·9% of deaths in those aged 5–19 years (figure). Country-specific and cause-specific death rates by age and year can also be visualised on a world map in the data portal. For example, Côte d'Ivoire, a country with 12 600 estimated premature neonatal deaths in 2021 has one of the highest rates, with 13·8 premature neonatal deaths per 1000 live births). Health and development before adulthood are crucial for human capital and for promoting healthy ageing across the life course.9Black RE Liu L Hartwig FP et al.Health and development from preconception to 20 years of age and human capital.Lancet. 2022; 399: 1730-1740Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar Under the Sustainable Development Goal (SDG) agenda, priority is given to the wellbeing and health of individuals of all ages, with specific targets to decrease early mortality due to maternal causes, communicable diseases, non-communicable diseases, and injuries for 2016–30.10UN General AssemblyTransforming our world: the 2030 agenda for sustainable development.https://sdgs.un.org/2030agendaDate: 2015Date accessed: September 11, 2023Google Scholar Progress is still needed to improve the survival of children and adolescents. Countries are requesting data to develop strategies targeting the leading causes of death in their populations to reduce mortality effectively.5Perin J Mulick A Yeung D et al.Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals.Lancet Child Adolesc Health. 2022; 6: 106-115Summary Full Text Full Text PDF PubMed Scopus (262) Google Scholar, 6Liu L Villavicencio F Yeung D et al.National, regional, and global causes of mortality in 5-19-year-olds from 2000 to 2019: a systematic analysis.Lancet Glob Health. 2022; 10: e337-e347Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar These estimates are now publicly available on the childmortality.org portal to meet this need and to spur progress towards the SDG survival targets by 2030. We declare no competing interests. This work is supported by the Bill & Melinda Gates Foundation (INV-038624 and OPP1172551 to LL and REB). FV acknowledges funding from the Spanish State Research Agency under the Ramón y Cajal programme (RYC2021-033979-I).